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Challenges of Costing a Surgical Procedure in a Lower–Middle-Income Country

World Journal of Surgery volume 43, pages 52–59 (2019)Cite this article

Abstract

Background

It is vital to enquire into cost of health care to ensure that maximum value for money is obtained with available resources; however, there is a dearth of information on cost of health care in lower–middle-income countries (LMICs). Our aim was to develop a reproducible costing method for three routes of hysterectomy in benign uterine conditions: total abdominal (TAH), non-descent vaginal (NDVH) and total laparoscopic hysterectomy (TLH).

Methods

A societal perspective with a micro-costing approach was applied to find out direct and indirect costs. A total of 147 patients were recruited from a district general hospital (Mannar) and a tertiary care hospital (Ragama). Costs incurred from preoperative period to convalescence included direct costs of labour, equipment, investigations, medications and utilities, and indirect costs of out-of-pocket expenses, productivity losses, carer costs and travelling. Time-driven activity-based costing was used for labour, and top-down micro-costing was used for utilities.

Results

The total cost [(interquartile range), number] of TAH was USD 339 [(308–397), n = 24] versus USD 338 [(312–422), n = 25], NDVH was USD 315 [(316–541), n = 23] versus USD 357 [(282–739), n = 26] and TLH was USD 393 [(338–446), n = 24] versus USD 429 [(390–504), n = 25] at Mannar and Ragama, respectively. The direct cost of TAH, NDVH and TLH was similar between the two centres, whilst indirect cost was related to the setting rather than the route of hysterectomy.

Conclusions

The costing method used in this study overcomes logistical difficulties in a LMIC and can serve as a guide for clinicians and policy makers in similar settings.

Trial registration

The study was registered in the Sri Lanka clinical trials registry (SLCTR/2016/020) and the International Clinical Trials Registry Platform (U1111-1194-8422) on 26 July 2016.

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References

  1. Fetter J, Shin Y, Freeman JL et al (1980) Case mix definition by diagnosis-related groups. Med Care 18(2):1–53

    Google Scholar 

  2. Busse R, Geissler A, Aaviksoo A et al (2013) Diagnosis related groups in Europe: moving towards transparency, efficiency, and quality in hospitals? BMJ (Clin Res ed.) 347(7916):1–7

    Google Scholar 

  3. Independent Hospital Pricing Authority (2015) The AR-DRG classification system. https://www.ihpa.gov.au/admitted-acute-care/ar-drg-classification-system. Accessed 19 April 2017

  4. Drummond M, Sculpher M, Torrance G et al (2005) Cost analysis. In: Methods for the economic evaluation of health care programmes. Oxford University Press, Oxford pp 55–102

  5. Gray AM, Clarke PM, Wolstenholme J, et al (2011) Defining, measuring, and valuing costs. In: Applied methods of cost-effectiveness analysis in health care, Oxford University Press, Oxford pp 119–142

  6. Negrini D, Kettle A, Sheppard L et al (2004) The cost of a hospital ward in Europe. J Health Org Manag 18(3):195–206. https://doi.org/10.1108/14777260410548437

    Article  CAS  Google Scholar 

  7. Lipscomb J, Yabroff KR, Brown ML et al (2009) Health care costing: data, methods, current applications. Med Care 47(7 Suppl 1):1–6

    Article  Google Scholar 

  8. Tan SS, Rutten FF, van Ineveld BM et al (2009) Comparing methodologies for the cost estimation of hospital services. Eur J Health Econ 10(1):39–45

    Article  CAS  PubMed  Google Scholar 

  9. Mercier G, Naro G (2014) Costing hospital surgery services: the method matters. PLoS ONE 9(5):e97290. https://doi.org/10.1371/journal.pone.0097290

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  10. Riewpaiboon A, Malaroje S, Kongsawatt S (2007) Effect of costing methods on unit cost of hospital medical services. Trop Med Int Health 12(4):554–563

    Article  PubMed  Google Scholar 

  11. Larsen J, Skjoldborg US (2004) Comparing systems for costing hospital treatments: the case of stable angina pectoris. Health Policy 67(3):293–307

    Article  PubMed  Google Scholar 

  12. Hendriks ME, Kundu P, Boers AC et al (2014) Step-by-step guideline for disease-specific costing studies in low- and middle-income countries: a mixed methodology. Glob Health Action 28(7):23573. https://doi.org/10.3402/gha.v7.23573.eCollection2014

    Article  Google Scholar 

  13. Grimes CE, Henry JA, Maraka J et al (2014) Cost-effectiveness of surgery in low- and middle-income countries: a systematic review. World J Surg 38(1):252–263

    Article  PubMed  Google Scholar 

  14. Ranson MK, John KR (2002) Quality of hysterectomy care in rural Gujarat: the role of community-based health insurance. Reprod Health Matters 10(20):70–81

    Article  PubMed  Google Scholar 

  15. Khan A, Zaman S (2010) Costs of vaginal delivery and Caesarean section at a tertiary level public hospital in Islamabad, Pakistan. BMC Pregnancy Childbirth 10:2

    Article  PubMed  PubMed Central  Google Scholar 

  16. Ekanayake CD, Pathmeswaran A, Kularatna S et al (2017) Cost evaluation, quality of life and pelvic organ function of three approaches to hysterectomy for benign uterine conditions: study protocol for a randomized controlled trial. Trials 18(1):1–10

    Article  Google Scholar 

  17. Parliment of the Democratic Socialist Republic of Sri Lanka (2016) The national minimum wage of workers act, no.3 of 2016. Sri Lanka

  18. Chatterjee S, Laxminarayan R (2013) Costs of surgical procedures in Indian hospitals. BMJ Open 3(6):e002844. https://doi.org/10.1136/bmjopen-2013-002844

    Article  PubMed  PubMed Central  Google Scholar 

  19. Wordsworth S, Ludbrook A, Caskey F et al (2005) Collecting unit cost data in multicentre studies: creating comparable methods. Eur J Health Econ 6(1):38–44

    Article  PubMed  Google Scholar 

  20. Ottosen C, Lingman G, Ottosen L et al (2000) Three methods for hysterectomy: a randomised, prospective study of short term outcome. BJOG Int J Obstet Gynaecol 107(11):5–1380

    Google Scholar 

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Acknowledgements

We are grateful to the Regional Director of Health Services-Mannar; Director, District General Hospital-Mannar; Director, North Colombo Teaching Hospital, Ragama. We acknowledge the contribution of the study participants and the staff of the two respective units. A special note of appreciation goes to the research assistants, Dr. Rienzie Pieris and Dr. Lakshika Liyanage.

Funding

This work was supported by the National Research Council Grant 16-086 from National Research Council of Sri Lanka.

Author information

Affiliations

  1. District General Hospital, Mannar, Sri Lanka

    Chanil Ekanayake

  2. Department of Public Health, Faculty of Medicine, University of Kelaniya, Kelaniya, Sri Lanka

    Arunasalam Pathmeswaran

  3. Australian Centre for Health Services Innovation, School of Public Health and Social Services, Queensland University of Technology, Brisbane, Australia

    Sanjeewa Kularatna

  4. Department of Obstetrics and Gynaecology, Faculty of Medicine, University of Kelaniya, Kelaniya, Sri Lanka

    Rasika Herath & Prasantha Wijesinghe

Authors
  1. Chanil Ekanayake
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  2. Arunasalam Pathmeswaran
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  3. Sanjeewa Kularatna
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  4. Rasika Herath
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  5. Prasantha Wijesinghe
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Corresponding author

Correspondence to Chanil Ekanayake.

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Ethics approval and consent to participate

Ethics approval was obtained from the ethics review committee of the Faculty of Medicine, University of Kelaniya (P/12/01/2016). All participants provided informed written consent to participate.

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Ekanayake, C., Pathmeswaran, A., Kularatna, S. et al. Challenges of Costing a Surgical Procedure in a Lower–Middle-Income Country. World J Surg 43, 52–59 (2019). https://doi.org/10.1007/s00268-018-4773-9

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  • DOI: https://doi.org/10.1007/s00268-018-4773-9